The Protean Manifestations of Varicella-Zoster Virus Vasculopathy

Gilden, Donald H.; Mahalingam, Ravi; Cohrs, Randall J.; Kleinschmidt‐DeMasters, Bette K.; Forghani, Bagher

doi:10.1080/13550280290167902

Cited by 65 publications

(58 citation statements)

References 21 publications

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“…As in adults, the CSF in children with VZV vasculopathy contains amplifiable VZV DNA or anti-VZV antibody, indicative of active infection (Table 1) and consistent with the detection of VZV antigen in granulomatous arteritis lesions of the left MCA of a 4-year-old girl who developed TIAs 8 months after varicella and died of malignant left hemispheric infarction 5 months later (15). Radiologically, PVA and VZV vasculopathy in childhood resemble the VZV vasculopathy described in immunocompromised patients and older adults (31), with large-vessel arteriopathy involving the anterior circulation reported most often in virologically-confirmed VZV vasculopathy in childhood (Table 1).…”

Section: Vzv Vasculopathy In Childrensupporting

confidence: 65%

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

Amlie‐Lefond

Gilden

2016

Journal of Stroke and Cerebrovascular Diseases

101

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Background-Varicella zoster virus (VZV) is a neurotropic exclusively human herpesvirus. Primary infection causes varicella (chickenpox), after which virus become latent in ganglionic neurons along the entire neuraxis. As cell-mediated immunity to VZV declines with advancing age and immunosuppression, VZV reactivates to produce zoster (shingles). One of the most serious complications of zoster is VZV vasculopathy.

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Section: Vzv Vasculopathy In Childrensupporting

confidence: 65%

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

Amlie‐Lefond

Gilden

2016

Journal of Stroke and Cerebrovascular Diseases

101

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“…Pathological studies have shown viral antigen and nucleic acid in the affected arteries. Encephalitis also results from a small-vessel vasculopathy that produces multiple infarcts in both cortical and subcortical gray and white matter combined with deep white matter ischemic or demyelinating lesions (8,93,95,96,129). Zoster infection in immunocompromised patients also may result in a necrotizing infection of ependymal cells resulting in ventriculitis and periventriculitis, usually presenting with hydrocephalus, altered mental status, and gait difficulty.…”

Section: Viruses For Which Pcr Has Potential Efficacy In Diagnosis Bumentioning

confidence: 99%

Molecular Methods for Diagnosis of Viral Encephalitis

2004

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Hundreds of viruses cause central nervous system (CNS) disease, including meningoencephalitis and postinfectious encephalomyelitis, in humans. The cerebrospinal fluid (CSF) is abnormal in >90% of cases; however, routine CSF studies only rarely lead to identification of a specific etiologic agent. Diagnosis of viral infections of the CNS has been revolutionized by the advent of new molecular diagnostic technologies to amplify viral nucleic acid from CSF, including PCR, nucleic acid sequence-based amplification, and branched-DNA assay. PCR is ideally suited for identifying fastidious organisms that may be difficult or impossible to culture and has been widely applied for detection of both DNA and RNA viruses in CSF. The technique can be performed rapidly and inexpensively and has become an integral component of diagnostic medical practice in the United States and other developed countries. In addition to its use for identification of etiologic agents of CNS disease in the clinical setting, PCR has also been used to quantitate viral load and monitor duration and adequacy of antiviral drug therapy. PCR has also been applied in the research setting to help discriminate active versus postinfectious immune-mediate disease, identify determinants of drug resistance, and investigate the etiology of neurologic disease of uncertain cause. This review discusses general principles of PCR and reverse transcription-PCR, including qualitative, quantitative, and multiplex techniques, with comment on issues of sensitivity, specificity, and positive and negative predictive values. The application of molecular diagnostic methods for diagnosis of specific infectious entities is reviewed in detail, including viruses for which PCR is of proven efficacy and is widely available, viruses for which PCR is less widely available or for which PCR has unproven sensitivity and specificity, and nonviral entities which can mimic viral CNS disease

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“…Only CSF negative for both VZV DNA and anti-VZV IgG antibody can reliably exclude the diagnosis of VZV vasculopathy [25]. On imaging, both cortical and deep-seated FLAIR hyperintensities can be seen; lesions at the gray-white matter junctions in particular, some of which enhance, provide strong supportive evidence to VZV as the cause of disease [27,28]. In the study by Nagel et al stated earlier, the prevalence of rash, CSF pleocytosis or vascular abnormalities on MRA/conventional angiography were seen in two thirds of the patients, while abnormalities on CT/MRI were seen in almost all patients with VZV vasculopathy [14].…”

Section: Investigationsmentioning

confidence: 92%

Central Nervous System Vasculopathy In Varicella Zoster Virus Infection

Mehta¹,

Desai²,

Mirtchev³

2017

J Neuroinfect Dis

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Varicella zoster virus is an exclusively human double-stranded DNA virus that is the causative factor for two ubiquitous conditions: varicella in children and zoster in adults. Both conditions are associated with neurological complications. Centripetal trans-axonal spread via cranial nerve ganglia appears to afford entry into the central nervous system. There is increasing evidence of varicella zoster virus playing a role in the development of giant cell arteritis. First associated with transient ischemic attacks and ischemic strokes, vasculopathy secondary to varicella zoster virus infections has now been associated with aneurysms that may or may not lead to subarachnoid hemorrhage, multifocal vasculitis, arterial dissection, dolicoectasia, cortical venous sinus thrombosis, ischemic cranial neuropathies and spinal cord infarction. Prior knowledge of the myriad clinical manifestations helps in early diagnosis and treatment of the complications.

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The Protean Manifestations of Varicella-Zoster Virus Vasculopathy

Cited by 65 publications

References 21 publications

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

Molecular Methods for Diagnosis of Viral Encephalitis

Central Nervous System Vasculopathy In Varicella Zoster Virus Infection

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